LPI Information Sheet - Dr Michelle Baker

Laser Iridotomy overview © Michelle Baker This overview provides general information related to Laser Iridotomy and does not take into account your personal circumstances

LASER IRIDOTOMY INFORMATION SHEET FOR ANGLE CLOSURE DISEASE

Laser Iridotomy

TABLE OF CONTENTS When Is A Laser Iridotomy Indicated?

How Does A Laser Iridotomy Work?

What To Expect On The Day Of Treatment What To Expect After Treatment Eyedrop After Laser Iridotomy Are There Any Risks Or Complications?

How Successful Is Laser Iridotomy?

Frequently Asked Questions How Can I Get More Information On Laser Iridotomy?

Who Can I Contact If I Am Having Problems?

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Laser Iridotomy

WHEN IS A LASER IRIDOTOMY INDICATED? How can I get more information on laser iridotomy?

1. From Your Opthalmologist (eye specialist) - Ask Me! 2. Glaucoma Australia LI Fact Sheet 3. American Academy of Ophthalmology 4. Frequently Asked Questions About Laser Iridotomy

There are many different types of glaucoma and the treatments are varied. Laser iridotomy is a treatment which is used for patients with angle closure disease.

Angle closure disease is associated with narrowing of the drainage angle, which drains the aqueous from the eye (natural fluid in the anterior chamber of the eye).

Acute angle closure glaucoma occurs suddenly when aqueous humour becomes blocked from draining out of the eye and the intraocular pressure (intraocular pressure) builds up very quickly. Chronic closed or narrow angle glaucoma can occur when the iris (coloured part of the eye) is pushed progressively forward onto the delicate drainage system, which then restricts the flow of aqueous humour so that the intraocular pressure increases. View Video Here.

The use of laser iridotomy is well established to treat and prevent an acute angle closure crisis and is used to prevent the intraocular rising in patients at risk.

HOW DOES A LASER IRIDOTOMY WORK?

The laser delivers a highly concentrated beam of energy which is used to make a small hole in the iris. This small hole allows the aqueous humour to flow freely from the posterior to the anterior of chamber at the front of the eye and then out through the drainage system, overcoming the pupillary block. View Video Here.

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Laser Iridotomy

WHAT TO EXPECT ON THE DAY OF TREATMENT? Please continue to use your eye drops/medications for glaucoma as normal, including on the day of treatment, unless instructed otherwise. Do not drive yourself to the clinic as you will be unable to drive home. Please allow 2 hours for your laser iridotomy procedure.

At the clinic we will first check your vision and intraocular pressure. It is possible for the intraocular pressure to increase after the treatment. Special eye drops will be instilled in your eye, before and after, the treatment to make the pupil smaller and decrease the intraocular pressure.

These drops are used to make the laser easier to perform and to prevent the intraocular pressure rising within your eye after the laser. The drops take up to one hour to work.

Prior to your procedure I will take your written consent and discuss the benefits and any risks with you, based on your individual needs and answer any questions.

The procedure usually takes less than 10 minutes to perform in each eye (unless you have a darkly pigmented iris). Just prior to the laser anaesthetic drops are instilled which numbs the surface of your eye. Once seated in front of the laser machine, which is similar to the microscope you will have been examined on in clinic, a special lens will be placed against the front surface of your eye. During the laser treatment you will hear clicking noises. You might feel a slight pain lasting a second or less and it could feel a little strange. The small hole in your iris is usually hidden under your upper lid and cannot be seen with the naked eye.

WHAT TO EXPECT AFTER TREATMENT After the procedure, your intraocular pressure will be checked one hour later. Before going home you will receive a prescription for a steroid eye drop to use at home and an appointment to come back to the clinic. Please continue any glaucoma eye drops, unless advised otherwise.

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Laser Iridotomy

You might wish to take pain relieving medication, for example paracetamol, to relieve any discomfort. If you are already taking pain relief for a different condition continue with those, but do not take both.

EYEDROP AFTER LASER IRIDOTOMY You will receive a prescription for a steroid drop to put in the eye(s) you have had lasered to reduce any inflammation caused by the laser and prevent the hole from closing.

Please instill the steroid drop every hour for the first 24 hours (when awake) then 4 to 6 hourly for one week. To improve drop retention, please instill the eye drop lying down on the bed, on one pillow, and then gently close your eyes for 5 minutes (to ensure drop retention).

ARE THERE ANY RISKS OR COMPLICATIONS? Laser iridotomy is a common and safe procedure but like any procedure it may have risks or complications which are usually self-resolving: • Red eye - For a few hours after the laser iridotomy you may find that the white of the eye appears red. This is usually due to the lens used on your eye during the treatment and will resolve.

• Blurred vision – Your vision may be blurred for a short time after laser treatment due to the eye drops used and bright light and will resolve usually within six hours. If you are concerned that your vision is not returning to normal please contact the clinic.

• Raised intraocular pressure – Some people’s eyes can have a transient intraocular pressure rise or spike after the laser treatment. This is the reason we re-check your eye pressure after the laser and we will give you additional treatment, if required. There is a small risk that your intraocular pressure may go up significantly which may cause a change or reduction in your vision and require additional treatment.

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• Anterior chamber bleeding (Hyphaema) - This is a common complication where there might be a little bleeding inside your eye, which will initially blur your vision; however, this will clear after a few days’ time.

The incidence and severity of anterior chamber bleeding has been reported to be similar whether a patient is on or off anticoagulants e.g. aspirin, clopidogrel, warfarin, so they do not need to be discontinued before laser iridotomy.

• Mild inflammation within the eye – Your eye might feel slightly bruised afterwards and sometimes your eye could become inflamed but the steroid drops you have been prescribed to use will control any inflammation and should help relieve discomfort.

• Diplopia - Very occasionally the small hole made in the iris can cause glare or double vision. If you suffer glare or other problems following your treatment please discuss this with me.

• Visual dysphotopsias - This is an uncommon phenomena due to light going through the laser hole and includes lines, haloes, spots, shadows and blurring. It usually resolves within weeks to months due to neuroadaptation. If persistent, it can be treated.

• Iridotomy closure and necessity for repeat laser iridotmy - Closure of the iridotomy has been reported to occur at a rate of between 1% at 2 weeks and 20% within the first 6 months. The vast majority remain patent. The topical steroid is prescribed to prevent iridotomy closure

HOW SUCCESSFUL IS LASER IRIDOTOMY?

Overall success rates for laser iridotomy have been reported to be about 75%. However, occasionally the small hole can partly or completely heal up in the first few days after the laser treatment. Further laser treatment might be necessary following your review in clinic. This is usually very successful. Laser iridotomy is very good at protecting against acute angle closure glaucoma.

The effectiveness of laser iridotomy in controlling intraocular pressure varies according to the stage of the angle closure disease, with earlier stages reporting the highest success rates. With higher initial intraocular pressures or glacuoma, cataract surgery may be superior to laser iridotomy.

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FREQUENTLY ASKED QUESTIONS

How long will I require off work?

You can usually return to work the next day.

Am I able to fly following laser treatment?

In most cases, there are no restrictions to flying, except in very rare circumstances.

Am I able to play sport, exercise, watch TV and read following the procedure?

Yes you can, however, if there has been bleeding in the eye you will be advised to withhold exercise for a period of time.

When am I able to drive?

Please do not drive yourself to the clinic as you will be unable to drive home. Your vision will be slightly blurred for a few hours following your laser treatment but this will settle.

HOW CAN I GET MORE INFORMATION ON LASER IRIDOTOMY? The information in this form is intended as guide only, as each patient’s experience will be different. If you require any further information or are concerned about your eye following laser treatment, please contact the clinical staff.

Where can I get more information on laser iridotomy?

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From Your Opthalmologist (eye specialist) - Ask Me! Glaucoma Australia LI Fact Sheet American Academy of Ophthalmology Frequently Asked Questions About Laser Iridotomy

WHO CAN I CONTACT IF I AM HAVING PROBLEMS? If you are experiencing pain or visual loss and are unable to contact the clinic staff, please attend the emergency department at the Royal Adelaide Hospital or Flinders Medical Centre as ophthalmic review is available 24 hours every day.

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